Long-Term Care Residential Options

There are many different types of homes or facilities where a person can live and get care services in a residential setting. One important consideration is whether the person will be using state funds (Medicaid) to pay for care. If state funds will be used, the home or facility must be licensed by Washington State and accept Medicaid payment for residents.

The Federal agency that has oversight for state certification of nursing facilities is the Center for Medicare and Medicaid Services (CMS). The state agency (SA) responsible for licensing and oversight is the Department of Social and Health Services (DSHS), Aging and Long-Term Support Administration (ALTSA), Residential Care Services (RCS) Division. Federal law requires DSHS to conduct an unannounced full health survey or inspection at least every 15 months.

Is a Nursing Home Your Only Choice?

Make sure to read through the other residential care housing options included on this page. There may be other alternatives for care in a more residential environment – including getting the care and services the person needs at home. Learn more about in-home services.

Adults receiving state-funds (Medicaid) to pay for long term care services may also be eligible for the Nurse Delegation Program. With Nurse Delegation, a caregiver may be trained to help with certain nursing type care tasks in your home, Assisted Living Facility, or adult family home. Learn more about Nurse Delegation.

Short-term Nursing Home Stays

Entering a nursing home no longer means every person stays forever. People also go to a nursing home for rehabilitation or for short-term, intensive nursing care. Often people get better or decide they want to return home and get services there.

Do you know someone preparing to leave a hospital, nursing home, or other health care setting? The CDC has developed a Planning for Your Discharge (PDF) checklist of important things patients and caregivers should know in order to plan for a safe discharge from a health care setting.

If you are needing short-term nursing home care, plan ahead for what types of services and support you may need after leaving the facility to return home or to another residential care setting. Depending on your situation, talk to a hospital discharge planner, nursing home discharge planner, staff at your local Senior Information and Assistance office, or your HCS case manager if you are receiving Medicaid services.

Adult Family Homes

Adult Family Homes are regular neighborhood homes where staff assumes responsibility for the safety and well-being of the adult. A room, meals, laundry, supervision and varying levels of assistance with care are provided. Some provide occasional nursing care. Some offer specialized care for people with mental health issues, developmental disabilities or dementia. The home can have two to six residents and is licensed by the state.

To explore an adult family home as an option, find out what kinds of services and supports are available at each home you are interested in. For more information about the types of questions to ask and things to look for when finding an adult family home, see our brochure: Choosing Care in an Adult Family Home or Assisted Living Facility.

Assisted Living Facilities

Assisted Living Facilities are facilities in a community setting where staff assumes responsibility for the safety and well-being of the adult. Housing, meals, laundry, supervision, and varying levels of assistance with care are provided. Some provide nursing care. Some offer specialized care for people with mental health issues, developmental disabilities, or dementia. The home can have seven or more residents and is licensed by the state.

Assisted Living Facilities that serve Medicaid clients are contracted by Washington State to provide three levels of service packages. Learn more about these service packages.

To explore an assisted living facility as an option, find out what kinds of services and supports are available at each of the different facilities you are interested in. For more information about the types of questions to ask and things to look for, see our brochure: Choosing Care in an Adult Family Home or Boarding Home.

Non state-licensed Options:

Retirement Communities/Independent Living Facilities

Retirement communities and independent living facilities are housing exclusively for adults (normally 55 or older). The person is generally healthy and any medical or personal care can be provided by visiting nurses or a home health aide. Staff at the retirement community does not take on the general responsibility for the safety and well-being of the adult.

There are all kinds of planned retirement communities from large scale, single family home developments to smaller-scale, senior houses or apartments.

Continuing Care Retirement Community (CCRC)

A Continuing Care Retirement Community (CCRC) is a residential community for adults that offers a range of housing options (normally independent living through nursing home care) and varying levels of medical and personal care services. A CCRC is designed to meet a resident’s needs in a familiar setting as he/she grows older. People most often move into such a community when they’re healthy.

A CCRC resident has to sign a long-term contract that provides for housing, personal care, housekeeping, yard care and nursing care. This contract typically involves either an entry fee or buy-in fee in addition to monthly service charges, which may change according to the medical or personal care services required. Fees vary depending on whether the person owns or rents the living space, its size and location, the type of service plan chosen, and the current risk for needing intensive long-term care. Because the contracts are lifelong and fees vary, it is important to get financial and legal advice before signing.